Akut Biliyer Pankreatit Hastalarında ERCP Gereksinimi Tahmin Edilebilir mi?

Giriş: Akut biliyer pankreatitin (ABP) en sık nedeni safra kesesi taş hastalığıdır. Hastaların büyük çoğunluğunda taşın düşmesi sonucu spontan iyileşme gözlenirken, düşmediği durumlarda ERCP ve sfinkterotomi işlemi ile taşın çıkartılması gerekebilir. Hangi hastada taşın spontan düşüp-düşmeyeceğini önceden bilmek mümkün değildir. Bu nedenle ERCP kararı medikal tedavi sırasında klinik durum ve laboratuvar değerlerine göre belirlenmektedir. ERCP yapılmasına gerek duyulabilecek hastaların bilinmesi klinisyen açısından öngörü sağlayacağı ve daha planlı bir tedavi sağlayacağı aşikardır. Bu çalışmada ERCP yapılacak hastaları belirleyecek prediktif değerlerin belirlenmesi amacıyla planlanmıştır.Gereç ve Yöntem: ABP nedeniyle tedavi edilen 179 hasta retrospektif olarak değerlendirildi. Hastalar ERCP yapılan (ERCP) ve spontan gerileyen (MEDİKAL) olmak üzere iki gruba ayrıldı. Hastaların demografik verileri, komorbit hastalıkları, biliyer ranson değerleri, biyokimyasal ve hemogram parametreleri ilk başvuru anında ve 48 saat (h) sonra kaydedildi.Bulgular: Grup MEDİKAL 160, grup ERCP ise 19 hastadan oluşmaktaydı. Gruplar arası değerlendirmede yaş ERCP grubunda farklı bulunurken, cinsiyet, biliyer ranson ve komorbit hastalıklarda fark bulunmadı. ROC analizinde amilaz (24h) <104.5, amilaz (48h) < 123.5, total bilürübin (48h) <2.15, direk bilürübin (48h) <1.45, kreatinin (48h)< 0.75 olan hastalarda ERCP yapılmasına gerek olmadığı anlamlı bulundu. 48 h deki lojistik regresyon analizi sonucuna göre amilaz değeri yüksek olan hastada 7.032, direk bilürübin değeri yüksek olan hastada 6.710, beyaz küre değeri yüksek olan hastada 4.287 kat fazla ERCP endikasyonu olduğu gösterildi. Sonuç: ERCP yapılması gereken hastaları belirlemek için ilk 24 h’de amilaz değeri, 48 h’de ise amilaz, direk bilürübin, beyaz küre değerleri prediktif değer olarak kullanılabilir.

Anahtar Kelimeler:

akut biliyer pankreatit, ERCP

Can ERCP Requirement be Predictable in Patients with Acute Biliary Pancreatitis ?

Introduction: Gallstone disease is the most common cause of acute pancreatitis. In many patients, spontaneous recovery is common after dropping of the stones into the common bile duct. Whereas, endoscopic retrograde cholangiopancreatography or sphincterotomy may be necessary to remove the stone in some cases where spontaneous dropping did not occur. It is unpredictable in which situations these gallstones will drop spontaneously. Therefore, the decision to perform an ERCP is generally depended on the clinical course and laboratory work-up. It is obvious that early prediction of the ERCP during admission will provide improvisation of a structured treatment plan. The present study sought to determine whether ERCP requirement might be predicted by some certain parameters in patients with gallstone disease. Patients and methods: Clinical records of a total of 179 patients with acute biliary pancreatitis (ABP) were retrospectively evaluated. Patients were divided into two groups as to receive ERCP (ERCP group – 19 patients) or have spontaneous recovery (Medical Group – 160 patients). Study data included demographics, history of comorbid diseases, biliary Ranson Scale Scores and laboratory findings. Parametric data were recorded on admission into the hospital and the assessments were repeated at 48th hour of admission. Results: Baseline characteristics including gender, biliary Ranson Scale Score and frequency of comorbidities were similar between two groups whereas age was significantly higher in ERCP group. ROC analysis revealed that ERCP was significantly unnecessary in patients with an amylase level <104.5 at 24th hour or <123.5 at 48th hour, total bilirubin <2.15 at 48th hour, conjugated bilirubin <1.45 at 48th hour or creatinine <0.75 at 48th hour. Logistic regression analysis revealed that risk of ERCP requirement was 7.032 fold higher in patients with high amylase levels, 6.710 fold higher in patients with high bilirubin levels, 4.287 fold higher in patients with high white blood cell count at 48th hour. Conclusion: ERCP requirement in gallstone disease may be predicted by amylase levels at 24th hour and by amylase, conjugated bilirubin and white blood cell count at 48th hour of admission.

Keywords:

Acute biliary pancreatitis, ERCP,

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Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi-Cover

ISSN: 1309-3320
Başlangıç: 2009
Yayıncı: Tokat Gaziosmanpaşa Üniversitesi

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